Pyogenic Cocci III. Gramnegative Coccobacilli
Pyogenic Cocci III. Gramnegative Coccobacilli
Pyogenic Cocci III. Gramnegative Coccobacilli
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<strong>Pyogenic</strong> <strong>Cocci</strong> <strong>III</strong>.<br />
<strong>Gramnegative</strong> <strong>Coccobacilli</strong><br />
Dr. Berek Zsuzsa<br />
21 October 2008
Neisseria, Haemophilus,<br />
Bordetella<br />
1. Neisseria
<strong>Pyogenic</strong> <strong>Cocci</strong> GRAM -<br />
Aerob: Oxidase +<br />
Neisseria N. gonorrhoeae P<br />
N. meningitidis P<br />
others (N. sicca, N. subflava, N. flavescens und<br />
apathogenic spp.)<br />
Moraxella M. catarrhalis<br />
Anaerob: Veillonella spp.<br />
Veillonellae vietsciences.free.fr
N. gonorrhoeae and N. meningitidis<br />
Morphology<br />
Gram negative<br />
Diplococci<br />
www.waterscan.co.yu/images
Gram negative Diplococci<br />
path.upmc.edu
N. gonorrhoeae and N. meningitidis<br />
Culture:<br />
Special demands<br />
Nutrient rich medium<br />
(Chocolate agar and<br />
5-10% CO 2 )<br />
Resistance:<br />
Sensitive bacteria:<br />
Dry, Heat, Disinfectants,<br />
Antibiotics<br />
Oxidase +<br />
path.upmc.edu
http://www.mfi.ku.dk/ppaulev/chapter33/images/33-3.jpg
N. gonorrhoeae = Gonococcus<br />
Antigens and Virulence factors:<br />
Pili/Fimbriae (Antigenvariations!)<br />
IgA-Proteases!<br />
outer membrane proteins (OMP)<br />
(Antigenvariations!)<br />
LOS (Mimikri!)<br />
Cell-wall Peptidoglycan (Toxic)
N. gonorrhoeae = Gonococcus
N. gonorrhoeae = Gonococcus<br />
textbookofbacteriology.net Pili
N. gonorrhoeae = Gonococcus<br />
Gonococcus-Lymphocyte Interaction<br />
neisseria.org/images/ng-lym2.jpg
N. gonorrhoeae = Gonococcus<br />
Source of infection<br />
Sick humans<br />
Transmission<br />
- Direct (sexual) Contact<br />
Clinical findings<br />
Gonorrhea = Tripper<br />
Ophthalmoblenorrhea neonatorum<br />
Generalisation 1%<br />
NO IMMUNITY!<br />
(Antigenvariants!)
Die Erreger des Trippers (Neisseria gonorrhoeae, hier blau)<br />
werden von fingerförmigen Fortsätzen auf der Zelloberfläche<br />
(grün) umschlossen. Im weiteren Verlauf der Infektion dringen<br />
die Bakterien dann in die Zelle ein.<br />
Max-Planck-Institut für Infektionsbiologie, Volker Brinkmann
Pathogenesis<br />
Medmicro
Gonorrhea – acute Urethritis<br />
www.stdservices.on.net www.boltonlgb.co.uk
Gonorrhea – acute Urethritis
Gonorrhea – acute Cervicitis<br />
www.boltonlgb.co.uk
Gonorrhea – acute Cervicitis
Gonorrhea – acute Conjuctivitis<br />
Blenorrhea neonatorum<br />
www.mc3.edu<br />
Corneal ulcers due to<br />
gonococcus are very<br />
destructive and have a<br />
tendency to perforate the<br />
cornea.<br />
www.slackbooks.com
Gonorrhea – Chronic and disseminated Form<br />
Endometritis,<br />
Salpingitis,<br />
Prostatitis<br />
purulent Arthritis,<br />
Vasculitis<br />
Important!<br />
anorectal Go and Pharyngitis<br />
(„alternative alternative Genitals”)<br />
Genitals
Fig. 8.33 Gonococcal<br />
septic arthritis. Arthritis<br />
due to N. gonorrhoeae in<br />
a 24-year-old woman,<br />
showing marked erythema<br />
and swelling of the right<br />
ankle and leg. By courtesy<br />
of Dr. T.F. Sellers Jr.<br />
Fig. 8.33 Gonococcal<br />
arthritis. Dactylitis<br />
secondary to gonococcal<br />
bacteriaemia. By courtesy<br />
of Dr. S.E. Thompson
Gonorrhea – Diagnosis – acute Disease<br />
Microscopic<br />
Direct detection – phagocytosed diplococci<br />
Gram staining<br />
www2.mf.uni-lj.si,<br />
www.uni-ulm.de,<br />
pathmicro.med.sc.edu<br />
Methylenblue staining, Direct Immunofluorescent (DIF)
GO – Gram staining – presumptive Diagnosis only!
GO – Gram staining – only presumptive Diagnosis!<br />
www.med.uni-giessen.de
Gonorrhea – Diagnosis<br />
Culture:<br />
„bedside” Thayer-Martin medium<br />
and chocolate agar, 5% CO 2<br />
Identification: ox+, glu+, mal-<br />
Antigen detection (direct):<br />
Latex-agglutination<br />
www2.mf.uni-lj.si,<br />
www.uni-ulm.de,<br />
pathmicro.med.sc.edu
Gonorrhea<br />
Therapy:<br />
3. Generation Cephalosporin (Ceftriaxone)<br />
or Spectinomycin (Aminoglycoside)<br />
Prophylaxis:<br />
GO<br />
- Exposition (safe sex)<br />
- Source of infection: find and treat!<br />
- Early Diagnosis and treatment<br />
Ophthalmia neonatorum:<br />
Application of 1% silver-nitrate in conjunctival sack<br />
NO VACCINE! (Antigenvariants!)<br />
www.tiscali.co.uk
N. meningitidis = Meningococcus<br />
scanning EM<br />
textbookofbacteriology.net
N. meningitidis = Meningococcus<br />
Antigens and Virulence factors:<br />
Capsule – Polysaccharide<br />
12 Serotype (A, B, C, W135, Y!)<br />
Pili/Fimbriae<br />
IgA-Proteases!<br />
Outer Membrane Proteine (OMP)<br />
LOS (Mimikri, sialisation: Serum resistant!)
Meningococcus<br />
zdsys.chgb.org.cn
N. meningitidis = Meningococcus<br />
Source of infection<br />
human – carriers (sick, healthy)<br />
Transmission, Portal of entry<br />
- Direct, drop-infection<br />
- Nose, throat<br />
Clinical finding<br />
Pharyngitis<br />
Meningitis cerebrospinalis epidemica<br />
Sepsis = Waterhouse-Friderichsen Syndrome
Fig. 10.56 Acute meningococcaemia. Note the variable size of the lesions and<br />
their peripheral distribution. Some of the lesions are obviously purpuric, others<br />
macular or papular.
Fig. 10.60 Acute meningococcaemia. Petechia on bulbar conjunctiva.
Fig. 10.62 Acute meningococcaemia. Gangrene of the extremities following a<br />
near-fatal illness with hypotension.
Fig. 10.63 Acute meningococcaemia. Gangrene of both legs in a black man<br />
with acute meningococcal infection. Bilateral below knee amputations were<br />
later required.
The characteristic skin rash of meningococcal septicaemia, caused by<br />
Neisseria meningitidis. (Courtesy of Wellcome Trust Photographic Library)<br />
srs.dl.ac.uk
Waterhouse – Friderichsen Syndrome - diagnosis<br />
www.lboro.ac.uk
Waterhouse- Friderichsen Syndrome: schwere nekrotisierende<br />
Hautläsionen bei Meningokokkensepsis mit Verbrauchskoagulopathie<br />
(R. E. Rieger, Univ.-Kinderklinik Marburg).<br />
© Urban & Fischer 2003 – Roche Lexikon Medizin, 5. Aufl.<br />
www.gesundheit.de
The patient with Waterhouse-Friderichsen syndrome has sepsis<br />
with DIC and marked purpura. medlib.med.utah.edu
Purulent meningitis with hemorrhage in the frontal lobe (gross findings).<br />
pathy.fujita-hu.ac.jp
Acute hemorrhage in bilateral adrenals caused acute adrenal<br />
insufficiency (Waterhouse-Friderichsen syndrome).<br />
pathy.fujita-hu.ac.jp
Meningitis Diagnosis<br />
Samples, specimen:<br />
Liquor (cerebrospinal fluid)! – Lumbal punction<br />
Blood<br />
carriers: throat
Meningitis Diagnosis<br />
Detection<br />
Microscopic examination<br />
(Liquor, blood culture)<br />
Culture<br />
Liquor, Blood, Throat<br />
Direct Ag detection<br />
(Liquor) – Latex-agglutination
Culture: Bloodagar,<br />
Chocolate agar<br />
Identification:<br />
glu+, mal+<br />
MIC (E-test)<br />
Diagnosis<br />
N. meningitidis
Meningococcus meningitis<br />
Therapy:<br />
Penicilline and/or<br />
Cephalosporine (<strong>III</strong>. Gen.)<br />
NO Beta-lactamase production<br />
Prophylaxis:<br />
Active Immunisation<br />
Vaccine for:<br />
- Risk groups<br />
- Traveler<br />
(Meningitis belt!)<br />
Chemoprophylaxis:<br />
Rifampicin (Contacts)
Meningitis belt
Neisseria meningitidis - B<br />
Europe!<br />
NO VACCINE!<br />
Rifampicin only<br />
www.versapharm.com
Neisseria, Haemophilus,<br />
Bordetella<br />
2. Haemophilus
GRAMNEGATIVE COCCOBACILLI<br />
Genus Species<br />
Haemophilus H. influenzae P<br />
H. parainfluenzae<br />
H. aegyptius P<br />
H. ducreyi P<br />
Bordetella B. pertussis P<br />
B. parapertussis<br />
P: Pathogen
Haemophilus influenzae<br />
Morphology:<br />
Gram - Coccobacillus,<br />
ca. 1 μm<br />
Cultivation:<br />
Growth factors !<br />
(chocolate,<br />
X= Haem, V= NAD,<br />
Satellite-phenomenon;<br />
Satellitism<br />
www.waterscan.co.yu/images
phil.cdc.gov<br />
Blood agar plate culture showing Haemophilus influenzae<br />
satelliting around Staphylococcus aureus.
Haemophilus influenzae<br />
Antigens and Virulence factors:<br />
Capsule – Polysaccharide<br />
Types: a, b, c, d, e, f (HiB!)<br />
IgA-Protease!<br />
surfaceantigens:<br />
Outer Membrane Proteine (OMP)<br />
LPS
Haemophilus influenzae<br />
Type b (Hib)<br />
www.soundmedicine.iu.edu
Haemophilus influenzae<br />
Clinical findings:<br />
Meningitis, Sepsis<br />
Cellulitis<br />
Upper respiratory tract:<br />
Epiglottitis!, Nasopharyngitis, Sinusitis, Otitis media<br />
Lower respiratory tract:<br />
Bronchitis, Pneumonia,
Haemophilus influenzae<br />
Sepsis<br />
An infant with severe vasculitis with disseminated intravascular coagulation (DIC) with<br />
gangrene of the hand secondary to Haemophilus influenzae type b septicemia - prior to<br />
the availability of the Hib vaccine.<br />
-Image provided by: Visual Red Book on CD-ROM-<br />
www.ecbt.org<br />
-(2000 Red Book: 25th Edition, Report of the Committee on Infectious Diseases)
Haemophilus influenzae<br />
Periorbital cellulitis.<br />
© Neal Halsy, MD www.cispimmunize.org
Haemophilus influenzae<br />
Clinical findings:<br />
Meningitis, Sepsis<br />
Cellulitis<br />
Upper respiratory tract:<br />
Epiglottitis!, Nasopharyngitis, Sinusitis, Otitis media<br />
Lower respiratory tract:<br />
Bronchitis, Pneumonia,
HiB-epiglottitis
Haemophilus influenzae<br />
Diagnosis:<br />
Samples, specimen<br />
LIQUOR! (CSF)<br />
Site of infection (Nose, throat, Sputum etc.)<br />
Detection:<br />
Microscopic, Culture,<br />
Capsule Ag detection (Latex-agglutination)<br />
Therapy:<br />
1. Ampicillin + <strong>III</strong>. gen. Cephalosporins<br />
2. Ampicillin + Aminoglycosides<br />
Prophylaxis:<br />
Active Immunisation - HiB Conjugate-Vaccine<br />
(Polysaccharide + Protein)
Lipopolysaccharid<br />
Extract - Vaccine<br />
ibs-isb.nrc-cnrc.gc.ca<br />
www.kmhk.kmu.edu.tw
Haemophilus ducreyi<br />
Causing: Ulcus molle = Chancroid =<br />
= soft Chancre<br />
Haemophilus aegyptius<br />
Causing: Brasilian Purpuric Fever<br />
Haemophilus parainfluenzae<br />
Pharyngitis, Endocarditis, Conjunctivitis
Ulcus molle
Ulcus molle
medinfo.ufl.edu
Chancroid in female<br />
www.smu.edu
Neisseria, Haemophilus,<br />
Bordetella<br />
3. Bordetella
KLEINE GRAMNEGATIVE STÄBCHEN<br />
Genus Species<br />
Haemophilus H. influenzae P<br />
H. parainfluenzae<br />
H. aegyptius P<br />
H. ducreyi P<br />
Bordetella B. pertussis P<br />
B. parapertussis<br />
P: Pathogen
Bordetella pertussis<br />
Morphology:<br />
<strong>Gramnegative</strong><br />
Coccobacillus,<br />
ca. 1 μm<br />
www.waterscan.co.yu/images
Bordetella pertussis<br />
Culture:<br />
Special Medium<br />
Bordet – Gengou<br />
nobelprize.org<br />
www.szu.cz
Bordetella pertussis<br />
Antigens and Virulence factors:<br />
Capsule<br />
Fimbriae, filamentous Haemagglutinin<br />
Outer Membrane Proteine (OMP)<br />
LPS<br />
Pertactin<br />
Extracellular Toxins:<br />
Pertussis Toxin<br />
Adenylatcyclase Toxin<br />
Tracheal cytotoxin<br />
Dermatonecrotic Toxin
FIGURE 31-2 Virulence factors of B pertussis.<br />
Medmicro
Pertussis toxin<br />
www.med.sc.edu:85
Bordetella pertussis<br />
Pathogenesis, Infection:<br />
Source: sick – in prodromal and catarrhal<br />
Stadium<br />
Portal of entry: Respiratory tract<br />
Transmission: drop-infection → sensitive!<br />
55°C; 30’
FIGURE 31-1 Pathogenesis of whooping cough.<br />
Medmicro
www.my-pharm.ac.jp
FIGURE 31-3 Binding of pertussis toxin to cell membranes.<br />
Medmicro
FIGURE 31-4 Synergy between pertussis toxin and the<br />
filamentous hemagglutinin in binding to ciliated<br />
respiratory epithelial cells.<br />
Medmicro
Bordetella pertussis<br />
Clinical finding:<br />
Whooping caugh / Pertussis<br />
(Peribronchial inflammation, Intersticiale Pneumonia)<br />
4-Phases:<br />
Prodromal,<br />
Catarrhal,<br />
Paroxysmal,<br />
Convalescent<br />
Colonization of tracheal epithelial cells by B. pertussis web.umr.edu/~microbio
Pertussis –<br />
paroxysmal Phase<br />
www.gesundes-kind.de,<br />
www.vaccineinformation.org
www.med.sc.edu<br />
www.thecrookstoncollection.com<br />
Lymphocytosis<br />
Pertussis - Diagnosis<br />
aapredbook.aappublications.org
Bordetella pertussis<br />
Diagnosis<br />
Cultivation:<br />
Bordet – Gengou<br />
Direct caugh!<br />
Charcoal Medium<br />
Serology:<br />
IgM, IgA, IgG Nachweis<br />
PCR<br />
medinfo.ufl.edu
Bordetella pertussis<br />
Therapy:<br />
Makrolides<br />
Prophylaxis:<br />
Active Immunisation – acellular Vaccine DaPT<br />
Toxoid<br />
FH/Pilus<br />
Pertactin<br />
DPT = DiPerTe – killed B. pertussis
Korfu, 2006<br />
THE END
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